FORM 1023-EZ for KING CITY COMMUNITY FOUNDATION

Field Data
EIN 82-1526688
Case Number EO-2017156-000128
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KING CITY COMMUNITY FOUNDATION
Organization’s Mailing Address 13631 SW CAPULET LANE
City KING CITY
State OR
ZIP 97224-2113
Accounting period End 12
Primary contact name JAIMIE FENDER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAIMIE FENDER
PRESIDENT
13631 SW CAPULET LANE
KING CITY OR 97224

Officer/Director/Trustee Two

ANNIE PAULSEN
SECRETARY TREASURER
17273 SW 136TH AVE
KING CITY OR 97224

Officer/Director/Trustee Three

VEVA JEAN GOEHLER
DIRECTOR
12700 SW BEEF BEND ROAD
KING CITY OR 97224

Officer/Director/Trustee Four

MAIYA MARTIN BURBANK
DIRECTOR
10805 SW FONNER ST
TIGARD OR 97223

Officer/Director/Trustee Five

MICAH PAULSEN
DIRECTOR
17273 SW 136TH AVE
KING CITY OR 97224

Organization’s website
Organization’s email KCCFOREGON@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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